WQ0033804_Monitoring - 01-2021_20210225

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0033804
Name of Facility:*
Month:* January
Report Information
Laurel Mountain Retreat
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
WQ0033804.pdf 6.72MB
FDF only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
[e-mail]
Kimber Reese
Reviewer: Williams, Kendall
2/25/2021
This will be filled in automatically

Is the project number correct? * WQ0033804
Is the monitoring report r Yes r No
accepted?*
Regional Office * Asheville
Accepted Date: 2/25/2021

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT ( DAR-1) Page of

Page 4 of �p
Did the application rates exceed the limits in Attachment B of your permit? E, /-mpliant El Non -Compliant
Were adequate measures taken to prevent effluent pending in or runoff from the sites? Vmpliant ID Non -Compliant
01
Was a suitable vegetative cover maintained on all sites as specified in your permit? pliant El Non -compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ;C-�pliant Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? :-Impliant El Non-Compliant
El Non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Perm ittee Certification
ORC: Robert Barr Permittee: Laurel Mountain Retreat
Certification No.: 24262 Signing Official: Robert Barr
Grade: S1 Phone Number: 828-251-1900 Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-11? El Yes ❑ No Phone Number: 828-251-1900 Permit Exp.: 1/31/22
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 05-16 NON-DISCHARGE'MONITORING REPORT (N R) Page of
EPermit Facility Narne: Laurel Mountain Ratret County. Buncombe Mt�n$h: January Year: 2021
PFlow Measuring Point: ❑ Influent � Effluent ❑ No flow generated Parameter monitoring Point: ❑ Influent n Effluent 0 Groundwater Lowering �] Surface Water
Parameter Code
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11016ifiWI-01
Page -4L of
Certified Laboratories
Name: Robert Barr Name: Pace Analytical, Inc.
Name: Kevin Bryan Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? dCompliant ❑ Non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Robert Barr Permittee: Laurel Mountain Retreat
Certification No.: 24262 Signing Official: Robert Barr
Grade: Sl Phone Number: 828-251-1900 Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? El Yes El No Phone Number: 828-251-1900 Permit Expiration: 1/31/2022
4V-
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations,
Mail Original and Two Copies to
Division of Water Resources
Information Processing Unit
16117 Mail Service Center
.1,110'Cir carofil,-